Predictors of liver failure after transarterial chemoembolization in patients with spontaneously ruptured hepatocellular carcinoma:A retrospective study

Background: Spontaneously ruptured hepatocellular carcinoma(rHCC) is a life-threatening condition. Transarterial chemoembolization(TACE) is a widely accepted treatment;however, it can lead to serious complications,especially liver failure. We sought to identify preoperative predictors of liver failure in patients with rHCC undergoing TACE.Methods: Patients with rHCC who received TACE as the initial therapy were retrospectively studied at our institution between January 2016 and December 2021. Based on the occurrence of liver failure after TACE, the patients were divided into liver failure and no-liver failure groups. Predictors of liver failure after TACE were analyzed using univariate and multivariate regression analyses. The predictive performance was assessed using the area under the curve(AUC). Delong’s test was used to compare predictive efficiency.Results: Sixty patients(19 and 41 in the liver failure and non-liver failure groups, respectively) were included.Multivariate analysis showed that preoperative prothrombin activity(PTA) level(odds ratio [OR], 0.956;95%confidence interval [CI], 0.920–0.994;P = 0.024) and Child-Pugh grade B(OR, 6.419;95% CI, 1.123–36.677;P= 0.037) were independent predictors of liver failure after TACE in patients with rHCC. The AUCs of the preoperative PTA levels and Child-Pugh grade B for predicting liver failure after TACE in patients with rHCC were0.783 and 0.764, respectively.Conclusion: Preoperative PTA level and Child-Pugh grade B were significant independent risk factors for liver failure after TACE in patients with rHCC. These can be used to predict liver failure after TACE in patients with rHCC for individual decision-making regarding treatment planning.

Feasibility and safety of sorafenib treatment in hepatocellular carcinoma patients with spontaneous rupture

AIM: To report the outcome of patients with ruptured hepatocellular carcinoma (HCC) treated at a single center during a 5-year period.

A new tumor-associated antigen prognostic scoring system for spontaneous ruptured hepatocellular carcinoma after partial hepatectomy

Objective:Spontaneous hepatocellular carcinoma(HCC)rupture can be fatal,and hepatic resection could achieve a favorable long-term survival among all strategies of tumor rupture.However,there is no available prognostic scoring system for patients with ruptured HCC who underwent partial hepatectomy.Methods:From January 2005 to May 2015,129 patients with spontaneous HCC rupture underwent partial hepatectomy.Preoperative clinical data were collected and analyzed.Independent risk factors affecting overall survival(OS)were used to develop the new scoring system.Harrell’s C statistics,Akaike information criterion(AIC),the relative likelihood,and the log likelihood ratio were calculated to measure the homogeneity and discriminatory ability of a prognostic system.Results:In the multivariable Cox regression analysis,three factors,including tumor size,preoperativeα-fetoprotein level,and alkaline phosphatase level,were chosen for the new tumor-associated antigen(TAA)prognostic scoring system.The 1-year OS rates were 88.1%,43.2%,and 30.2%for TAA scores of 0–5 points(low-risk group),6–9 points(moderate-risk group),and 10–13points(high-risk group),respectively.The TAA scoring system had superior homogeneity and discriminatory ability(Harrell’s C statistics,0.693 vs.0.627 and 0.634;AIC,794.79 vs.817.23 and 820.16;relative likelihood,both<0.001;and log likelihood ratio,45.21 vs.22.77 and 21.84)than the Barcelona Clinic Liver Cancer staging system and the Cancer of the Liver Italian Program in predicting OS.Similar results were found while predicting disease-free survival(DFS).Conclusions:The new prognostic scoring system is simple and effective in predicting both OS and DFS of patients with spontaneous ruptured HCC.

Predictors and clinical outcomes for spontaneous rupture of hepatocellular carcinoma

AIM:To determine the risk factors for hepatocellular carcinoma(HCC) rupture,and report the management and long-term survival results of patients with spontaneous rupture of HCC.METHODS:Among 4209 patients with HCC who were diagnosed at Eastern Hepatobiliary Surgery Hospital from April 2002 to November 2006,200(4.8%) patients with ruptured HCC(case group) were studied retrospectively in term of their clinical characteristics and prognostic factors.The one-stage therapeutic approach to manage ruptured HCC consisted of initial management by conservative treatment,transarterial embolization(TACE) or hepatic resection.Results of various treatments in the case group were evaluated and compared with the control group(202 patients) without ruptured HCC during the same study period.Continuous data were expressed as mean ± SD or me-dian(range) where appropriate and compared using the unpaired t test.Categorical variables were compared using the Chi-square test with Yates correction or the Fisher exact test where appropriate.The overall survival rate in each group was determined using the Kaplan-Meier method and a log-rank test.RESULTS:Compared with the control group,more patients in the case group had underlying diseases of hypertension(7.5% vs 3.0%,P =0.041) and liver cirrhosis(87.5% vs 56.4%,P < 0.001),tumor size >5 cm(83.0% vs 57.4%,P < 0.001),tumor protrusion from the liver surface(66.0% vs 44.6%,P < 0.001),vascular thrombus(30.5% vs 8.9%,P < 0.001) and extrahepatic invasion(36.5% vs 12.4%,P < 0.001).On multivariate logistic regression analysis,underlying diseases of hypertension(P = 0.002) and liver cirrhosis(P < 0.001),tumor size > 5 cm(P < 0.001),vascular thrombus(P = 0.002) and extrahepatic invasion(P < 0.001) were predictive for spontaneous rupture of HCC.Among the 200 patients with spontaneous rupture of HCC,105 patients underwent hepatic resection,33 received TACE,and 62 were managed with conservative treatment.The median survival time(MST) of all patients with spontaneous rupture of HCC was 6 mo(range,1-72 mo),and the overall survival at 1,3 and 5 years were 32.5%,10% and 4%,respectively.The MST was 12 mo(range,1-72 mo) in the surgical group,4 mo(range,1-30 mo) in the TACE group and 1 mo(range,1-19 mo) in the conservative group.Ninety-eight patients in the control group underwent hepatic resection,and the MST and median diseasefree survival time were 46 mo(range,6-93 mo) and 23 mo(range,3-39 mo) respectively,which were much longer than that of patients with spontaneous rupture of HCC undergoing hepatic resection(P < 0.001).The 1-,3-,and 5-year overall survival rates and the 1-,3-and 5-year disease-free survival rates in patients with ruptured HCC undergoing hepatectomy were 57.1%,19.0% and 7.6%,27.6%,14.3% and 3.8%,respectively,compared with those of 77.1%,59.8% and 41.2%,57.1%,40.6% and 32.9% in 98 patients with-CONCLUSION:Prolonged survival can be achieved in selected patients undergoing one-stage hepatectomy,although the survival results were inferior to those of the patients without ruptured HCC.

Spontaneous rupture of hepatocellular carcinoma: a retrospective study of 87 patients in a teaching hospital

Objective: The aim of the study was to review the management of ruptured hepatocellular carcinoma (HCC) in a single teaching hospital over 13-year period; to determine the prognostic factor of in-hospital mortality and evaluate the safety and efficacy of liver resection. Methods: A retrospective collection of medical records of 87 patients with spontaneous ruptured HCC was carried out. The 28 patients underwent emergency intervention including transarterial chemoembolization (TACE) and laparotomy with/without liver resection. Conservative treatment was performed in 59 patients and 16 of which underwent delayed hepatectomy or TACE. Results: The overall in-hospital mortality and median survival time was 54% and 22 days respectively. Albumin level (OR = 0.874, 95% CI: 0.778-0.973, P = 0.024), number of tumors (OR = 5.011, 95% CI: 1.015-24.750, P = 0.048) and laparotomy (OR = 0.069, 95% CI: 0.012-0.406, P = 0.003) were all independent factors affecting overall in-hospital mortality, but for patients undergone laparotomy, only total bilirubin level (OR = 1.138, 95% CI: 1.024-1.264, P = 0.016) was independent factor affecting overall in-hospital mortality. Age, total bilirubin level, maximum tumor size, number of tumors, portal vein tumor thrombosis and extra-hepatic metastasis were all significantly different between groups with laparotomy and without. There were no significant differences between emergency and delayed liver resection groups in in-hospital mortality (0 vs. 0), median survival time (788 vs. 750 days respectively) as well as 1-year and 3-year survival rates (66.7%, 44.4% vs. 70%, 30%, respectively) (P = 0.763, log-rank test). Conclusion: Both underlying chronic liver disease and tumor stage can affect the in-hospital mortality, but for patients undergone laparotomy, only total bilirubin level is independent factor. Surgeons are more prone to choose patients with younger age, better liver function and earlier tumor stage to do surgery. In well selected patients, both emergency and delayed liver resections are safe and could achieve prolonged survival.

Metabolic imaging for guidance of curative treatment of isolated pelvic implantation metastasis after resection of spontaneously ruptured hepatocellular carcinoma: A case report

Spontaneous rupture of hepatocellular carcinoma(HCC) is a life-threatening complication and its prognosis is significantly poor because of the high recurrence rate after initial hepatectomy. Resection of isolated extrahepatic metastasis of HCC has been advocated to obtain a possibility of long-term survival. However, it is a challenge for clinicians to detect implantation metastasis of spontaneously ruptured HCC. Accurate re-staging plays the most important role in making a decision on isolated metastasis resection. 18F-fluorodeoxyglucose(18F-FDG) positron emission tomography/computed tomography(PET/CT) is useful in detecting intraabdominal implantation metastasis from a variety of malignancies and shows superior accuracy to conventional imaging modalities in determining the location of metastasis. We present one patient with a new isolated pelvic implantation metastasis detected by 18F-FDG PET/CT and pathologically confirmed by PET/CT-guided percutaneous biopsy, who had a history of resection of spontaneously ruptured HCC two years ago. The patient's condition was stable at the 6-mo follow-up after resection of the isolated pelvic metastasis.

Do we really need a standardized approach to spontaneously ruptured hepatocellular carcinoma?

Hepatocellular carcinoma(HCC)is one of the leading causes of cancer-related death in Asian and African countries due to a high prevalence of chronic hepatitis B infections(1,2).The vast majority of current studies focus on the treatment of HCC itself rather than complications from HCC.A potentially life-threatening complication of HCC is spontaneous rupture,and its prevalence has been reportedly to be 5-15%of all HCC cases(1).This is the third leading cause of HCC-related death after tumor progression and liver failure,and there is a high mortality associated with rupture(3,4).

Risk factor analysis of perioperative mortality after ruptured bleeding in hepatocellular carcinoma

AIM: To discuss strategies and prognosis for the emergency treatment of ruptured bleeding in primary hepatocellular carcinoma.

Hydrochloric acid-enhanced radiofrequency ablation for treating a large hepatocellular carcinoma with spontaneous rapture:a case report

Background:A ruptured hepatocellular carcinoma(HCC)is often fatal.In addition to surgery and transarterial embo?lization,radiofrequency ablation(RFA)might be another option for treating a ruptured HCC.Unfortunately,conven?tional RFA has a limited ablation zone;as such,it is rarely used to treat ruptured tumors.Case presentation:This case was a 60?year?old man who had a large,ruptured HCC in which hydrochloric acid(HCl)?enhanced RFA successfully controlled the bleeding and made the tumor completely necrotic.Conclusion:Considering the effectiveness of HCl?enhanced RFA in achieving hemostasis and tumor ablation,it might be a new option for treating large,ruptured HCCs.

肝癌自发性破裂出血患者经肝动脉化疗栓塞术后感染的影响因素分析

目的:调查肝癌自发性破裂出血患者经肝动脉化疗栓塞术(TACE)后感染情况,分析其影响因素。方法:选取2018年9月—2022年9月于孝感市中心医院行TACE的肝癌自发性破裂出血患者107例作为研究对象,根据患者术后是否出现感染分为感染组和非感染组,比较两组相关资料,分析肝癌自发性破裂出血患者TACE后感染的影响因素。结果:107例肝癌自发性破裂出血患者术后发生感染40例。合并糖尿病、存在乙型病毒性肝炎病史、发生休克、术中出血量大是肝癌自发性破裂出血患者TACE后感染的独立危险因素,清蛋白水平高是肝癌自发性破裂出血患者TACE后感染的独立保护因素(P<0.05)。结论:肝癌自发性破裂出血患者TACE后感染的独立影响因素包括合并糖尿病情况、乙型病毒性肝炎病史、清蛋白水平、休克情况、术中出血量,临床应对术后高危感染人群制定针对性防控措施。

肝细胞癌自发性破裂危险因素分析及术前临床预测模型建立

目的探讨肝细胞癌自发性破裂的危险因素并建立术前临床预测模型。方法收集2011年3月至2020年5月中国医科大学附属第一医院132例肝细胞癌自发性破裂患者(破裂组)及性别、年龄、体质量指数相匹配的132例未发生肝细胞癌破裂患者(对照组)的临床资料。单因素分析比较2组各项临床指标的差异。将单因素分析具有统计学差异(P<0.1)指标纳入多因素回归分析,探讨肝细胞癌自发性破裂的危险因素。基于肝细胞癌自发性破裂相关的独立危险因素构建预测列线图。采用受试者操作特征曲线及校准曲线评估列线图的区分度及校准度,并通过Bootstrap自抽样法对预测模型进行验证。结果单因素分析结果显示,Child-Pugh分级、国际标准化比值、谷丙转氨酶、最大肿瘤直径、肿瘤是否位于肝左叶、瘤内血管强化(增强CT)、肿瘤突出于肝脏表面、肿瘤累及肝段数2组比较有统计学差异(均P<0.05)。多因素回归分析结果显示,Child-Pugh分级B或C级、最大肿瘤直径>5 cm、增强CT显示瘤内血管强化、肿瘤突出于肝脏表面、国际标准化比值高是肝细胞癌自发性破裂的独立危险因素(均P<0.05)。本研究成功构建了术前临床预测列线图。预测模型对肿瘤是否会发生自发性破裂的区分力良好,受试者操作特征曲线下面积为0.868。Bootstrap法内部验证结果说明模型预测结果与实际观察值一致性良好。结论肝细胞癌患者出现肝功能储备差、最大肿瘤直径>5 cm、增强CT检查可见瘤内血管强化、肿瘤突出于肝脏表面、国际标准化比值高时更容易发生肿瘤自发性破裂。构建的术前临床预测模型可以准确识别肝细胞癌自发性破裂风险的高危人群,因此可以尽早对患者进行危险分层,改善患者预后。

腹腔镜肝切除术治疗肝癌破裂出血的初步经验

目的评估腹腔镜肝切除术治疗肝癌破裂出血的临床价值。方法回顾性分析该院2016年1月-2019年9月采用腹腔镜肝切除术治疗肝癌破裂出血的7例患者的临床资料。结果7例患者均顺利完成腹腔镜手术,与对照组比较,术中出血量明显减少,术后住院时间明显缩短,差异均有统计学意义(P<0.05)。7例患者均无切口及腹腔种植,两组患者无瘤生存率及总生存率比较,差异均无统计学意义(P>0.05)。结论对于循环稳定、肝功能分级为Child—Pugh A级、肿瘤可切除、能耐受手术的肝癌破裂出血患者,行腹腔镜肝切除术是安全和可行的。

破裂性肝细胞癌的研究现状与急救护理进展

肝细胞癌(HCC)自发性破裂出血进展为破裂性肝细胞癌(rHCC),rHCC是HCC致命性并发症之一。rHCC病情危重、复杂,治疗和护理困难。目前临床上的治疗方法有保守治疗、介入治疗、手术治疗等,既往rHCC直接被纳入T4期,但现有研究表明及时治疗和护理可以有效控制病情进展,延长患者生存时间。本文对rHCC的诊断、发病机制、治疗和急救护理进行综述,以期为临床医生诊疗提供指导,为急救护理提供经验。

动脉介入栓塞治疗肝癌破裂出血

目的分析原发性肝癌自发性破裂出血经动脉介入栓塞(TAE或TACE)治疗的效果。方法回顾性分析安徽省立医院2008年8月-2011年11月的11例采用急症介入栓塞治疗的原发性肝癌破裂出血患者的临床资料。结果 11例患者均得以成功止血,术后30 d生存10例(90.9%),术后3个月生存6例(54.5%),术后1年生存3例(27.2%)。结论 TAE(TACE)是治疗肝癌破裂出血的有效方法,不仅能达到立即止血,提高患者生存率的目的 ,还能为后续进一步治疗创造条件。

手术切除与肝动脉介入栓塞化疗治疗原发性肝癌破裂出血比较及预后分析

目的比较手术切除与肝动脉介入栓塞化疗两种方法治疗原发性肝癌破裂出血的近期疗效及远期生存时间,探讨最合理的治疗选择,分析影响原发性肝癌破裂出血患者远期生存时间的因素。方法回顾性分析2000年1月至2009年12月我院收治的61例原发性肝癌破裂出血患者临床资料,其中32例采用手术切除治疗(手术组),29例采用肝动脉介入栓塞化疗(TACE组),对两组近期疗效、远期生存时间进行分析,并运用COX回归模型分析影响手术患者预后的相关因素。结果两组患者近期疗效无统计学差异。手术组患者中位生存时间为(27.00±5.65)个月,TACE组为(10.00±4.49)个月,手术组患者中位生存时间为TACE组患者2.7倍,差异存在统计学意义(t=3.728,P<0.01)。COX回归模型分析结果提示门静脉癌栓、分化程度是影响手术组患者预后的独立危险因素(P<0.05)。结论手术切除和TACE均是治疗原发性肝癌破裂出血的有效手段,但手术切除患者的生存时间较长,是治疗肝癌破裂出血首选,门静脉癌栓、分化程度可能是影响手术组患者预后的独立危险因素。

肝动脉化疗栓塞联合粒子植入治疗肝癌自发性破裂出血的临床研究

目的探讨肝动脉化疗栓塞(TACE)联合粒子植入治疗肝癌自发性破裂出血的临床疗效。方法 50例肝癌自发性破裂出血患者分为单纯组(20例)和联合组(30例),联合组行急症肝动脉栓塞术(TAE)→^(125)I放射性粒子植入→TACE术序贯治疗,单纯组急症TAE术→TACE序贯治疗。治疗1个月后患者均接受彩色多普勒超声、CT检查并比较两组患者AFP水平变化、肿瘤缩小率、1、2年生存率和不良反应。结果联合组AFP正常率、肿瘤缩小率和1、2年生存率分别为85.7%、90%、90%、66.6%,明显高于单纯组的33.3%、65%、55%、30%(均P<0.05);而不良反应方面,两组比较,差异无统计学意义(P>0.05)。结论 TACE联合粒子植入治疗肝癌自发性破裂出血患者,可充分发挥其优势,明显增加治疗效果,并延长患者的生存期。

选择性动脉栓塞治疗原发性肝癌自发破裂出血的疗效及预后分析

目的探讨初诊行选择性动脉栓塞(TACE)治疗原发性肝癌自发破裂出血的疗效及预后相关因素。方法回顾性分析2012年6月至2016年6月,初诊接受选择性TACE治疗的57例原发性肝癌自发破裂出血的患者。末次随访时间为2016年10月。采用Kaplan-Meier法计算累积生存率,Cox回归模型分析生存预后因素。结果 57例患者,中位生存期为208 d,6个月、1年、2年累积生存率分别为50.3%、35.9%、14.7%。多因素Cox回归分析显示:肿瘤直径、Child-Pugh分级、休克病史以及栓塞材料是患者预后的独立相关因素。结论初诊行选择性TACE治疗肝癌自发破裂出血安全、有效。本研究显示,较大的肿瘤直径,Child-Pugh分级不佳,休克病史与患者预后不良有关。同时,碘油联合明胶海绵颗粒TACE治疗患者可以获得比单纯PVA颗粒栓塞更好的预后。

肝动脉化疗栓塞术治疗肝癌破裂出血

目的 探讨肝动脉化疗栓塞术 (TACE)在治疗肝癌破裂出血中的临床应用价值。 方法 采用Seldinger技术 ,使用明胶海绵、碘化油加化疗药物混悬剂作为栓塞剂 ,对 14例肝癌破裂出血患者行肝动脉化疗栓塞术。 结果 有活动性出血的 12例中 10例控制出血 ,有效率为 83 3% ( 10 / 12 ) ,2例 4 8h内死于失血性休克 ,院内死亡率为 14 3% ( 2 / 14 )。 1例术后 2个月死于肝功能衰竭 ,1例术后 2个月获二期外科手术切除。随访 10例 ,8例先后接受TACE治疗 1～ 4次 ,平均生存 7 8月 ,1年以上者 5例 ,占 35 7% ( 5 / 14 )。

TACE后二期手术治疗小肝癌破裂出血的临床研究

目的 探讨小肝癌破裂出血行TACE后二期手术的治疗效果.方法 21例小肝癌破裂出血患者先行TACE治疗,并于1～2个月后行手术切除（联合治疗组）;同时以18例小肝癌破裂出血患者行急诊手术切除作为对照（对照组）;比较两组止血成功率、围手术期输血量、住院病死率、术后并发症、术后生存率和住院天数.结果 两组患者止血成功率均为100％,联合治疗组与对照组相比围手术期输血量少、并发症发生率低、住院天数短,差异有统计学意义（P＜ 0.01）,但病死率和生存率无差异（P＞0.05）.结论 TACE治疗后二期手术治疗小肝癌破裂出血虽然不能延长患者生存时间,但更具安全性,是临床值得应用的治疗方法.

明胶海绵颗粒与Embosphere生物微球栓塞治疗原发性肝癌破裂出血对比观察

目的探讨明胶海绵颗粒与Embosphere生物微球栓塞治疗原发性肝癌破裂出血的效果。方法回顾分析近5年来收治的49例(使用明胶海绵23例,使用Embosphere生物微球26例)经导管肝动脉明胶海绵和Embosphere生物微球栓塞治疗的原发性肝癌破裂出血患者的临床资料,评价即时止血和再次出血率。结果明胶海绵组和Embosphere生物微球组即时止血率均为100%;在明胶海绵栓塞治疗后7天内再次出血率为13.0%(3/23),1例转外科手术,1例再次介入治疗,术后成功止血,1例因突发失血性休克死亡;在Embosphere生物微球栓塞后7天内再次出血率为3.8%(1/26),显著低于明胶海绵组(P<0.01)。结论明胶海绵和Embosphere生物微球治疗肝癌破裂出血即时止血效果相同,但Embosphere生物微球治疗术后再出血风险明显减少。